心力衰竭的诊断及治疗__培训课件.ppt

临床表现 肺水肿：端坐呼吸、恐惧、濒死感、大汗、咳粉红色泡沫痰 心动过速、奔马律、两肺底湿啰音 诊断 症状和体征 胸片：肺水肿（双肺门蝶状高密度阴影） PCWP：30mmHg 需与支气管哮喘鉴别 高流量吸氧：湿化瓶中加酒精 减少静脉回心血量：坐位、两腿下垂 镇静：吗啡、地西泮（安定） 利尿：静脉推注速尿 血管扩张剂：硝普钠、硝酸甘油 强心甙：西地兰 氨茶碱、皮质激素 机械通气：CPAP、NIPPV、气管插管 血液滤过（CVVH） IABP 治疗 心衰是可以预防的！ 心力衰竭的发生和发展是一个“进行性”过程，表现为左室进行性扩大和球形伴收缩功能进行性降低（即左室重塑），逐渐发展到心力衰竭，并使心衰不断进展直到死亡。 心衰的预防 建立良好的生活方式 积极治疗，血压达标，血糖达标，血脂达标 选择对心脏有保护作用的药物，如ACEI和ARB 什么是良好的生活方式？ 戒烟限酒 合理膳食 适量运动 心理平衡 控制危险因素 1.积极控制高血压 2.有效控制糖尿病 3.加强冠心病的一级和二级预防用药 4.控制感染 * * Heart failure currently affects 4.79 million persons in the United States alone,1 and this number is expected to rise to 10 million by 2037.2 Approximately 550,000 new cases of heart failure are diagnosed each year. Risk of sudden cardiac death is 6 to 9 times higher in the heart failure population.1 The prevalence of heart failure increases with age, affecting 10% of persons aged 70 years and older.3 References: American Heart Association. 2002 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association; 2001. Croft JB, Giles WH, Pollard RA, et al. National trends in the initial hospitalization for heart failure. J Am Geriatr Soc. 1997;45:279–275. National Heart, Lung, and Blood Institute. Congestive Heart Failure Data Fact Sheet. Available at: /health/public/heart/other/CHF.htm. Accessed December 2002. * * 对HF认识的逐渐演变也导致了不同时期心衰治疗原则及药物的变化 * 1. McMurray J, Pfeffer MA. New therapeutic options in congestive heart failure. Part I. Circulation. 2002;105:2099-2106. Chronic HF can be thought of as a state of neurohormonal imbalance in which the activity of potentially harmful pathways outweighs that of favorable pathways.1 The pathophysiologic basis of therapy in HF currently involves blunting progression through the use of neurohumoral antagonists that inhibit undesirable pathways, notably the SNS and the RAAS in patients with low LV ejection fraction (LVEF). New peptides, such as endothelins, and other mediators, such as cytokines and free radicals, may also play a rol